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, <br /> ` �t <br /> � <br /> ` � ����' o� O���TO <br /> Post Office Box 66•Crystal Bay,I�tinnesota 5�323•M�dpal Qffices <br /> M • <br /> • pn the North Shore of Lake Minnetonka - <br /> • ' • � <br /> DATA PRSV'AC� ��S�RY <br /> � "Rights of sub j ects of <br /> Subd. 2. ermit or <br /> In accordance with M.S• 13•ou�that your request for a P uire <br /> data", We Would like to inform Y of its departments maY req <br /> licease from the City of Orono or any <br /> Y <br /> ou to furnish certain private or confidential information. <br /> You are notified that: <br /> The information you furnish will be uuested. aetermine your <br /> 1. e�-�nit or license req <br /> qualification for the p require that <br /> refuse to supply data, but refusal may <br /> 2, You �aY the permit or license. <br /> the City deny <br /> be snared with other local , s�ate or <br /> 3. The information may <br /> rocess the permit oi <br /> f ederal agencies to the extent necessary to p <br /> license. <br /> a If our requested permit or Iicense u�e�c res Councii a�='-or <br /> y become p <br /> to approve, some iniormation may <br /> �, You have <br /> certain ri.ghts under M.S. 13.04 to review private <br /> data on yourself. <br /> 6 . <br /> Your full name is required to procsss this application or <br /> p e rznit. <br /> ��. , �p � � <br /> '�''��"� r d1e Last <br /> First <br /> M�a �� <br /> � �� � <br /> Addres s � �53 <br /> a� J Z1P <br /> State <br /> Cit C�,� <br /> / ~ � . <br /> Phone <br /> hts as ated above. <br /> I unders d �Y g , � <br />;: . <br />� <br />�, . <br /> Si na ure <br /> . • PUBLIC WORKS-473-7359 <br /> BUILDING&ZONING-473-7357 • ADMINiSTRATION&FINANCE-473-7358 <br /> ASSESSING <br />